1. Are subpopulations of children potentially susceptible to adverse reactions to vaccines, such as children with a family history of autoimmune disease or allergies or children born prematurely?

The committee recognizes not only that additional information is needed to address parental concerns but also that other factors will affect parental decision making. For example, in the testimony and online comments, the committee identified skepticism about (1) the quality of vaccine research (prelicensure and postmarketing), (2) the influence of pharmaceutical companies on scientific research, and (3) the influence of the governmental entities that oversee vaccine research. In addition, as stated earlier, clear and effective parent-provider communication is essential to convey accurate information and foster mutual trust.

The committee’s review of the determinants of public trust in vaccination campaigns and information on vaccines identified three types of concerns raised by stakeholders:

  • knowledge and expertise,
  • openness and honesty, and
  • concern and care.

Thus, improved communication between public health authorities and parents requires improvements to the clarity of the information and the effectiveness with which the information is conveyed, as well as the building of trust and the use of a systematic approach to elicit public concerns. Further research into the impact of parental perceptions about risk on their decisions about immunizing their children is indicated, and that research should be performed by methods that use decision and social science (Larson et al., 2011).

The committee acknowledges that parents and providers are not the only stakeholders who are concerned about the safety of the immunization schedule. The committee listened to presentations from a range of stakeholders whose concerns focused on providing immunizations to preserve community immunity and to prevent the reemergence of vaccine-preventable diseases, which ultimately requires the cooperation and trust of parents in immunizing their children. These other groups and individuals who also have a vested interest in providing children with a safe and effective immunization schedule include pharmaceutical companies; federal, state, and local governments; health insurers; the many health care providers who oversee administration of vaccines; and many others in the health care system.

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